vi. 4) Date:30.09.2020 Indian Oil Corporation Limited Haldia Refinery ADVISORY oncoviD-19 INTER-STATE AND INTRA-STATE TRAVELLERS All INTER -STATE asymptomatic traveller arriving at Heldia shall report to Haldia Refinery Hospital and inform their travel details . Haldia Refinery Hospital will issue a reference slip to such traveller for undergoing Covid-18 test from a designated centre . The concerned person shall be in home isolation till his /her test report is received . If they are tested negative , they will report to Haldia Refinery Hospital for medical check- up and obtain a medical fitness for their joining based on which they will resume their duty . However they will closely self-monitor their health for 14 days . In case, during self-monitoring period (14 days), they develop any symptom they will inform the same to HR hospital Over telephone (Intercom ~ 03224 - 4321) for necessary medical intervention. If any case INTER -STATE asymptomatic traveller is tested positive , further course of action will be advised by HR Hospital, All INTRA-STATE asymptomatic travellers should undergo medical check-up and obtain 2 medical fitness from Haldia Refinery Hospital for their joining. They shall self-monitor their health for 14 days. All symptomatic travelers ( Both INTER-STATE and INTRA-STATE) arriving at Haldia shall contact Haldia Refinery Hospital over telephone (Intercom — 03224- 4321) . Further course of action in such cases would be advised by Haldia Refinery Hospital . They would be allowed to join based on a Medical Certificate issued by HR hospital, as and when deemed fit by the Hospital. Format of Undertakings to be submitted ~ (A) For IOCL Employees & Dependents and (8) For other than IOCL employees is enciosed . The undertaking is required to be submitted to the concerned HOD. Besides the above guidelines , The following shall continue to be ensured by all employees, their dependents & all other stakeholders: Any person arriving at Haldia Refinery from any location will have to download Arogya Setu Apo and keep Bluetooth activated. 0Sh, Indian Oil Corporation Limited Haldia Refinery He should also have to Compulsory weer of Face Masks at public / work place, maintain norms of social distancing at work place, ensure hand hygiene at all times by frequent washing of hands with soap and water or use of alcohol based hand sanitizers. He should also ensure compliance of various advisories pertaining to COVID -19 issued by IOCL / Govt authorities from time to time(4 Indian Oil Corporation Limited Haldia Refinery FORMAT~A(INTRA-STATE AND INTER-STATE TRAVELLERS) UNDERTAKING (For IOCL Employees and Dependents) |, Shri / Smt. = EMP No. Designation. Grade Section Department hereby undertake that; 1. 1 have traveled from District State__ Country ‘on Date 2, The above location IS / IS NOT (delete whichever is not applicable) a CONTAINTMENT ZONE (As declared by Govt of India or Govt of Concerned State or Govt of West Bengal ) 3. Ihave travelled / not travelled to or from any containment zone in last 14 days (delete whichever is not applicable ) 4. Ihave reached Haldia on Date 5. Ihave NO Symptoms / MILD Symptoms (for COVID-19) (delete whichever is not applicable) 6. | have given my sample / my sample & my dependents’ sample travelling with me at Hospital / Diagnostic Centre on (To be filled up only in applicable cases) 7. Immediately after availabilty of test result | will contact Haldia Refinery Hospital for further advice (To be filled up only in applicable cases) 8 Ihave reported for medical checkup at Haldia Refinery Hospital on 9. Myself & my family members have been advised Self Monitoring of Health from (Date) to ____ (Date) and Home isolation from __(Date) to__(Date) . | shall intimate Haldia Refinery Hospital immediately if | or my family members develop symptoms of COVID ~ 19 during the Self Monitoring Period . Myself & my family members shall undergo covid test , whenever advised by Haldia Refinery Hospital . (To be filled up only in applicable cases). 10. 1/1 and My dependents have downloaded and installed Arogya Setu App on my / our mobile phones and my / our Bluetooth is activated. 41. | shall obtain Medical fitness Certificate before joining duties at Haldia Refinery. hereby understand and Undertake that the information provided as above are true to the best of my knowledge. | Undertake that at any time, if | am found to have concealed any fact on the above, Haldia Refinery Management will institute suitable disciplinary action against me. Date: feta Signature: Name: EMPNo:__Desgn. Address Phone / MobileIndian Oil Corporation Limited ( 4h 4) Haldia Refinery \ EORMAT-B (INTRA-STATE AND INTER-STATE TRAVELLERS) TAKING [For othi loyees) 1, Shri / Smt. ___ Designation ES ‘Company hereby undertake that; 1. | have traveled from District State. Country on Date 2. The above location IS / 1S NOT (delete whichever is not applicable) a CONTAINTMENT ZONE (As declared by Govt of India or Govt of Concerned State or Govt of West Bengal. 3. | have travelled / not travelled to or from any containment zone in last 14 days (delete whichever is not applicable } 4. | have reached Haldia on Date , | have NO Symptoms / MILD Symptoms (for COVID-18) (delete whichever is not applicable) 6. | have given my sample / my sample & my dependents’ sample travelling with me at Hospital /Diagnostic Centre on : (To be filed up only in applicable cases) 7. Immediately after availability of test result | will contact Haldia Refinery Hospital for further advice .(To be filled up only in applicable cases) 8. | have reported for medical checkup at Haldia Refinery Hospital on 9. Myself & my family members have been advised Self Monitoring of Health from (Date) to (Date) and Home Isolation from ___(Date] to (Date) . | shall intimate Haldia Refinery Hospital immediately if | or my family members develop symptoms of COVID — 19 during the Self Monitoring Period . Myself & my family members shall undergo covid test , whenever advised by Haldia Refinery Hospital . (To be filled up only in applicable cases). 10. | / | and My dependents have downloaded and installed Arogya Setu App on my / our mobile phones and my / our Bluetooth is activated. 11, | shall obtain Medical fitness Certificate before visiting Haldia Refinery | hereby understand and Undertake that the information provided as above are true to the best of my knowledge. | undertake that at any time, if | am found to have concealed any fact on the above, |OCL, Haldia Refinery Management will institute suitable punitive actions against me and my Company / Organization Date: Signature: Name: Designation, Address Phone / Mobile